Download TraumaCad™ User`s Guide

TraumaCad™
User's Guide
Version 1.6
A TraumaCad Ltd. Document
Copyright 2006
Version 1.6
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Important Notice
TraumaCad User's Guide
Important Notice
Copyright and Trademark Notices
All contents of this document are Copyright 2006 Orthocrat Ltd.
All rights reserved. TraumaCad™ is a trademark of Orthocrat Ltd. The trademarks, logos
and service marks displayed on this documents are the property of Orthocrat Ltd or other
third parties. Users are not permitted to use these trademarks, logos and service marks
without the prior written consent of Orthocrat Ltd, or such third parties as may own them.
Limited License
Orthocrat Ltd, hereby gives license to review these documents solely for non-commercial
use within your organization, provided that you do not modify the content of the documents
and provided any copies made retain all copyright and other proprietary notices contained
therein. The information provided in these documents is permitted solely to users to provide
information in support of Orthocrat Ltd products. No other use of the information provided
hereunder is authorized.
Nothing contained herein shall be construed as conferring by implication, estoppel or
otherwise any license or right under any patent or trademark of Orthocrat Ltd or any third
party. Except as expressly provided above, nothing contained herein shall be construed as
conferring any license or right under any Orthocrat Ltd or third party copyright.
Limitation of Liability
Information provided on this documents is provided "AS IS" and is provided without
warranty of any kind, either express or implied, including, without limitation, warranties of
merchantability, fitness for a particular purpose, and non-infringement. Orthocrat Ltd uses
reasonable efforts to include accurate and timely information on this web site and
periodically updates the information without notice. However, Orthocrat Ltd makes no
warranties or representations as to the accuracy or completeness of such information, and
Orthocrat Ltd assumes no liability or responsibility for errors or omissions in the content of
this documents. Your use of these documents is AT YOUR OWN RISK. Under no
circumstances, and under no legal theory or provision shall Orthocrat Ltd be liable to you or
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damages arising from your access to, or use of, these documents.
Important Notice
TraumaCad User's Guide
Product information is subject to change without notice. Changes, if any, will be
incorporated in new editions of publications provided in these documents. Orthocrat Ltd
retains the right to make improvements and/or changes in the products and/or the programs
described in the publications and information provided on these documents at any time and
without prior notice. Mention of non- Orthocrat Ltd products or services is for information
purposes only and constitutes neither an endorsement nor a recommendation of such
products or services.
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These documents may contain information of parties other than Orthocrat Ltd. Such
information is provided for your convenience and reference only. The said information is not
under the control of Orthocrat Ltd, and Orthocrat Ltd is not responsible for the contents of
any of such information. The inclusion of this information does not imply any association
with their operators or any endorsement of the said third parties by Orthocrat Ltd.
Disclaimer
This software is intended as a decision support system for persons who have received
appropriate medical training, and should not be used as a sole basis for making clinical
decisions pertaining to patient diagnosis, care, or management. All information derived from
the software must be clinically reviewed regarding its plausibility before use in treating
patients. Any deviation of the application of medical information from the program, other
than the original design or intended use there of, is not advised and considered a misuse of
the software product. For additional guidance, see published studies.
0344
This device complies with the Requirements of the 93/42/EEC
Directive Concerning Medical Devices.
Authorized representative address:
CEpartner4U B.V.
Nijverheidsstraat 5
2624 BA Delft
The Netherlands
Phone: +31 15 257 6682
Fax: +31 15 257 6683
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Table of Contents
TraumaCad User's Guide
Table of
Contents
Chapter 1 Getting Started with TraumaCad......................................... 1
What is TraumaCad? .............................................................................................................1
Using TraumaCad...................................................................................................................2
Installing TraumaCad ...........................................................................................................3
Importing Implant Templates ...............................................................................................3
Importing the Digital X-ray ..................................................................................................3
Specifying Anatomical Orientation ......................................................................................3
Displaying the Image............................................................................................................4
Calibrating the Image ...........................................................................................................4
Performing Pre-operative Evaluation and Planning and Selecting Surgical Procedures ......4
Saving and Archiving ...........................................................................................................4
Standalone or Client/Server ...................................................................................................5
System Requirements..............................................................................................................7
Installing TraumaCad ............................................................................................................8
How to Install TraumaCad....................................................................................................9
Launching TraumaCad .......................................................................................................13
Quick Tour of the TraumaCad Interface............................................................................15
Toolbar ...............................................................................................................................16
Setting the PACS Configuration (Optional) .......................................................................21
Table of Contents
TraumaCad User's Guide
Downloading Implant Templates ........................................................................................ 22
Templates Manager............................................................................................................ 24
Chapter 2 Preparing the Image .............................................................27
Loading Images from a PACS............................................................................................. 29
Finding the Patient ............................................................................................................. 29
Selecting the Patient’s Images ........................................................................................... 31
Importing Images from a CD .............................................................................................. 32
Capturing Images from the Screen ..................................................................................... 33
Specifying Anatomical Orientation..................................................................................... 34
Calibrating the Image .......................................................................................................... 36
X-ray Scaling ..................................................................................................................... 37
Calibration Sphere ............................................................................................................. 38
Calibration Window........................................................................................................... 39
Calibrating an Image.......................................................................................................... 41
Chapter 3 TraumaCad Procedures .......................................................45
Joint Replacement Procedures ............................................................................................ 46
Selecting an Implant .......................................................................................................... 47
Specifying Implant Properties............................................................................................ 49
Positioning an Implant ....................................................................................................... 51
Trauma
.................................................................................................................... 52
Specifying the Anatomical Region .................................................................................... 53
Reducing the Bone Fragments ........................................................................................... 55
Marking Anatomical Points for the Pediatric Pelvis Tool ................................................. 60
Generating Reports .............................................................................................................. 64
Chapter 4 Measuring the Anatomy.......................................................69
Ruler Tool
.................................................................................................................... 70
Angle Tool
.................................................................................................................... 71
Circle Tool
.................................................................................................................... 72
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Leg Length Discrepancy Tool ..............................................................................................73
Spine Tools
.....................................................................................................................74
Sacral Obliquity..................................................................................................................74
Coronal Balance .................................................................................................................75
Sagittal Balance ..................................................................................................................75
Cobb Angle.........................................................................................................................76
Pediatric Tools .....................................................................................................................77
Reimer Index ......................................................................................................................77
Foot and Ankle Tools ............................................................................................................78
Talar Tilt Tool ....................................................................................................................78
Geometrical Research Tools.................................................................................................79
Cup Inclination ...................................................................................................................79
AnteRetro version of the Femoral Stem .............................................................................80
Pelvic Tools
.....................................................................................................................81
Pelvic Radius Angle ...........................................................................................................81
VCA Angle of Luquesne ....................................................................................................82
Growth Calculator ................................................................................................................83
Chapter 5 Limb Alignment Analysis………………………………….90
Marking Anatomical Points……………………………………………………………….. 91
Bilateral…………………………………………………………………………………... 92
Unilateral…………………………………………………………………………………. 96
Lateral …………………………………………………………………………………….99
Osteotomies Simulation …………………………………………………………………...102
About This Guide
TraumaCad User's Guide
About This
Guide
This guide is intended for surgeons who are performing pre-operative
evaluation and planning for orthopedic procedures.
This guide contains the following chapters:
Chapter 1, Getting Started with TraumaCad, page 1, describes the
purpose of TraumaCad, its system requirements, how to install it, how
to launch it and provides a quick tour through its interface.
Chapter 2, Preparing the Image, page 27, describes how to use
TraumaCad to load the required images, specify their anatomical
orientation and calibrate the images.
Chapter 3, TraumaCad Procedures, page 45, describes how to use
TraumaCad for pre-operative evaluation and planning for a variety of
orthopedic procedures.
Chapter 4, Measuring Anatomy, page 69, describes how to use the
various tools provided by TraumaCad to measure the anatomy
represented in an image.
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Contacting Us
TraumaCad User's Guide
Contacting Us
US Office
173 S. Portland Ave.
Floor 3
Brooklyn, NY 11217
Telephone (877) 2111-804
Fax (801) 881-5239
[email protected]
[email protected]
Israeli Office
35 Efal St, 12th floor
Petah-Tikva, 49511, Israel
Telephone 972-3-9290929
Fax 972-3-9236413
Safety Symbols
The following symbols are used throughout the documentation. Please pay
particular attention at specific points in a procedure when one of the
following messages appears.
WARNING!
A WARNING! denotes a hazard. It calls attention to a procedure that, if not
correctly performed or adhered to, could result in injury or loss of life. Do not
proceed beyond a warning note until the indicated conditions are fully understood
and met.
NOTE:
Notes provide pertinent information to help obtain optimum performance from the
program.
Getting Started with TraumaCad
TraumaCad User's Guide
4Chapter 1
Getting Started
with TraumaCad
What is TraumaCad?
TraumaCad allows surgeons to evaluate and manipulate digital images
while performing various pre-operative surgical planning and evaluation of
images.
TraumaCad enables increased productivity and improves patient safety.
The program features full PACS integration and an extensive regularly
updated library of digital templates from the leading manufacturers.
TraumaCad provides easy to use wizards for planning the following
procedures:
Total Joint Replacement: Knee, Hip, Elbow, Shoulder, Ankle
Trauma
Pediatric Pelvis Tool
TraumaCad also provides a variety of tools which are especially suited for
the measurement of pelvic, knee, spine, pediatric foot and ankle images.
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Using TraumaCad
The following provides a chronological overview of the process of using
TraumaCad.
Installing TraumaCad
Importing Implant Templates
Importing the Digital X-ray
Specifying Anatomical
Orientation
Displaying the Image
Calibrating the Image
Performing Pre-operative
Evaluation and Planning
Saving and Archiving
Getting Started with TraumaCad
TraumaCad User's Guide
Installing TraumaCad
Installation of TraumaCad™ must be performed on a computer that is
connected to the Web. TraumaCad can be installed from either a CD or
downloaded from Orthocrat’s website. For more information, refer to page
2.
NOTE:
For standalone versions of TraumaCad, the PACS Configuration must first be set
up in order to specify the connection properties between TraumaCad and the
PACS system. Typically, this only needs to be performed once by a system
administrator after the initial installation of TraumaCad. The system administrator
should make sure to enter the relevant connection properties in the PACS system
so that it recognizes TraumaCad. For more information refer to page 22.
Importing Implant Templates
TraumaCad provides a large library of templates, which is loaded and
constantly updated — automatically for the server version and manually for
the standalone version, as described on page 23.
Importing the Digital X-ray
TraumaCad is transparently integrated with the PACS system and enables
full access to its patient images and information. TraumaCad provides a
variety of options for finding a specific patient of interest. After you have
found the patient, you can select the images in which you are interested.
For more information, see the Loading Images from a PACS section on
page 29.
Specifying Anatomical Orientation
After an image is displayed, whether it was imported from a PACS system
or a CD, you must specify its anatomical orientation. For more information,
refer to page 34.
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Displaying the Image
TraumaCad supports DICOM and enables you to import and export any
PACS file (X-ray, CT or MR) from a central PACS system, a CD or from a
local workstation. JPG, scanner or digital camera images can also be
imported, as described on page 27.
Calibrating the Image
TraumaCad’s automatic calibration tool facilitates precise calibration to the
actual bone size, as described on page 28.
Performing Pre-operative
Evaluation and Planning
TraumaCad provides a simple wizard that will walk you though the process
of pre-operation evaluation and planning for surgical procedures, as
follows:
Joint Replacement Procedures, page 46
Trauma, page 53
Pediatric Pelvis Tool, page 60
Saving and Archiving
Once the planning of a procedure is completed, a full report is saved, which
includes the image, the implants and the measurements that were marked
on it. This report is stored in the patient’s PACS file, ensuring convenient
access.
Getting Started with TraumaCad
TraumaCad User's Guide
NOTE:
In addition, TraumaCad provides a series of anatomical measurement tools in
manual, semi-automatic and automatic mode. In addition to length, width and
diameter, these tools measure leg length discrepancy, Cobb angle, mechanical and
anatomic axis measurement, mal-alignment tests and more. These tools can be
used on an image at any time. For more information, refer to Chapter 4, Measuring
the Anatomy, page 69.
TraumaCad also provides a Growth Analysis tool, which provides various options
for predicting the growth of a particular anatomy in pediatric orthopedics. For more
information, refer to the Growth Calculator section on page 83.
Standalone or Client/Server
TraumaCad is installed and runs locally on your computer and interacts
with a PACS system. Both a standalone and a client/server version of
TraumaCad are available.
The standalone version runs on a specific computer only and stores all its
files, such as its configuration and implant templates, on that specific
computer.
The client/server version is comprised of a server application that is setup
by the administrator, as described in the TraumaCad™ Server Control
Panel Guide, and client applications that run on specific computers.
These two types of applications operate in a very similar manner and there
are only slight differences in functionality, as described below:
Standalone Functionality
All the functionality described in this guide is available in the standalone
version.
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TraumaCad User's Guide
Client/Server Functionality
All the functionality described in this guide is available in the client/server
version except for those listed below. The features that are not available are
performed by the administrator. Some of these administrator features apply
to all the TraumaCad applications running in an organization, such as the
library of implant templates, and some are user-specific according to the
user that logs in to a client, as described in the TraumaCad Administrator’s
Guide.
There is no need to specify the connection properties between
TraumaCad and the PACS system because this is performed by the
administrator, and therefore the PACS Configuration button is not
applicable in the client version.
An organization that runs the client/server version is assigned a certain
number of licenses, and the quantity of TraumaCad applications that
can run simultaneously (concurrent users) is determined by this license.
The following are handled by the administrator, and the client does not
need to perform them:
Import Image button in the main window
Import DICOM Folder button in the main window
Download Template button in the main window
Screen Capture option in the File menu that captures any image
that is displayed on the screen into TraumaCad.
User specific preferences are defined by the administrator on the server,
and therefore the TraumaCad Settings button is not applicable for the
client version.
Getting Started with TraumaCad
TraumaCad User's Guide
System Requirements
Hardware
512 MB of RAM
Processor: P4 1.8 GHZ or higher
Minimal screen resolution: 1024 x 768
40MB free hard disk space and additional disk space for templates
Software
MS Windows 2000 or later
MS .Net Framework version 1.1 or higher (this will be installed or
upgraded during setup)
Internet Explorer 6.0 or higher
Clinical Requirements
In order to perform accurate templating, the image should be calibrated.
Image requirements may differ according to the image source:
Uncalibrated images: A metal calibration sphere with a known
diameter (typically 1 inch) must be placed at the bone level prior to
taking the image.
DICOM images with a preset calibration attribute acquired from
the modality: There is no need for a physical marker.
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Installing TraumaCad
Installation of TraumaCad must be performed on a computer that is connected
to the Web. TraumaCad can be installed from either a CD or downloaded
from Orthocrat’s website at www.ortho-cad.com.
NOTE:
After installation and the first launch, TraumaCad does not need to be connected
to the Web.
Installing from a CD
If you are installing from a CD, the following window is displayed
automatically:
Click on TraumaCad time-limited trial version.
Getting Started with TraumaCad
TraumaCad User's Guide
Installing via the Web
If you are installing via the Web, launch Internet Explorer and enter the
URL of the organization's server that runs TraumaCad BackOffice. The
following window is displayed:
Click Start Here and when asked whether to run or save the program,
select Run. Then, follow the procedure described below.
How to Install TraumaCad
The TraumaCad installation program will check if Windows.Net is installed
on your computer. If not, it will download and install it. You are then
required to restart your computer. If you are installing from a CD, do not
remove it from the drive.
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To install TraumaCad:
1 The Welcome window is displayed, as shown below:
Click Next. The License Agreement window is displayed, as shown
below:
Getting Started with TraumaCad
TraumaCad User's Guide
2 Read the License Agreement. If it is acceptable to you, select I
accept the terms of the license agreement and click Next to display
the following window:
3 Enter your User Name and Organization, and then select who you
want to be able to access the program. Click Next to display the
following window:
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TraumaCad User's Guide
4
Review the displayed installation settings. If you want to change any
of them, click Back. If you want to proceed with the installation click
Install. TraumaCad now starts installing.
5 When the installation is complete the Installation Wizard Completed
window is displayed.
Click Finish to complete the installation process.
Getting Started with TraumaCad
TraumaCad User's Guide
Launching TraumaCad
TraumaCad requires an activation key to operate and must be connected
to the Web the first time it is launched. A trial activation key is valid for
60 days, after which you can contact your system administrator or
Orthocrat sales in order to be sent a permanent one.
To launch TraumaCad:
1
Double-click the TraumaCad icon that was installed on your desktop:
If this is not the first time that TraumaCad is launched on this
computer, the main window is displayed, as shown in the Quick Tour of
the TraumaCad Interface section on page 16.
If this is the first time that TraumaCad is launched on this computer,
the following window is displayed:
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2 At this stage, you must enter the activation key provided by Orthocrat
in order to launch TraumaCad for the first time. This can be done in
any of the following ways:
Enter the activation key provided on the CD or sent to you in the
Enter Activation Key field.
Or
Click the Create License Request button to generate a license
request file. Each license request only applies to the computer from
which it is generated. Deliver this request file to Orthocrat, for
example by email, and a license file will be sent to you. Copy this
license file to this computer, and then use the Install License File
button to activate TraumaCad using this license.
Or
Click the Phone Activation button to display a window showing a
key that you should read out to Orthocrat on the phone. Orthocrat
will then tell you or send you activation data and a license key that
you can enter into the window. Then, click OK.
Getting Started with TraumaCad
TraumaCad User's Guide
3 Once you enter a valid activation key, the Online Activation button
becomes active. Enter information about yourself in the displayed
window and click OK to display the following:
4 Click OK to display the main window of the application, as shown on
the following page.
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Quick Tour of the TraumaCad
Interface
This section provides a brief overview of the features of the TraumaCad
application, and describes its main window and toolbar. The main window
displays a list of patients and their images. It also serves as the main work
area in which you can measure anatomy, select an appropriate implant or
plan for an operation.
Menu Bar
Toolbar
Find
Patients
and
Images
Import
Images
Patients
and
Images
List
Status Bar
The main window contains the following areas:
Menu Bar: Provides the menu bar options that enable access to various
TraumaCad functions.
Toolbar: Provides the tools that enable quick access to TraumaCad’s
most frequently used functions, as described in the Toolbar section on
page 17.
Import Images: Provides various options for importing images, as
described on page 27, and for downloading implant templates, as
described on page 23.
Getting Started with TraumaCad
TraumaCad User's Guide
Status Bar: Indicates the status of the application. For example,
Querying PACS, Retrieving Images, and so on.
Find Patients and Images: Provides various options for finding the
patients and images in the PACS that you would like to study, as
described in the Finding a Patient and Selecting the Patient’s Images
section starting on page 29.
PACS Configuration (Optional): Enables you to specify the
connection properties between TraumaCad and the PACS system, as
described in the Setting the PACS Configuration (Optional) section on
page 22. This option is only relevant for the standalone version of
TraumaCad.
TraumaCad Settings (Optional): Enables you to specify various user
settings, such as font size color. TraumaCad automatically provides
various defaults for these setting and they only need to be modified if
you would like to change them according to your preferences. This
option is only relevant for the standalone version of TraumaCad.
Toolbar
The following provides a brief description of each of the tools in the
TraumaCad toolbar, and when relevant, provides a reference to the section
of this guide that provides more information.
Move: Enables you to click on an object in the image and to move
this object by dragging the mouse. Click this tool, click on an object that
was drawn using TraumaCad on the image, such as an implant, a fragment
or textual annotation, hold down the mouse button and then move the
mouse to move the object.
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Pan: Enables you to move the image itself. Click this tool, click on
the image and hold down the mouse button. Then move the mouse to move
the image. You can also use the mouse wheel to pan the image by
simply holding the wheel down and then moving the mouse to move the
image.
Zoom: Enables you to zoom in (enlarge) or zoom out (shrink) the
image view. Click this tool, click on the image, hold down the mouse
button and then drag the mouse up to zoom in or down to zoom out. You
can also use the mouse wheel to zoom by rolling it upwards to zoom in
and downwards to zoom out.
Windowing: Enhances the visible distinction between contrasting
tissue regions by manipulating the brightness and contrast. Position the
cursor on the image, and click this tool. Left-click on the image and drag
the mouse left or right to change the contrast, and up or down to change the
brightness.
Define Fragments: Enables you to draw an outline around a
fragment to be moved in the image by clicking around its edges, as
described in the Reducing the Bone Fragments section on page 56.
Lasso Fragments: Enables you to draw an outline around a
fragment to be moved in the image by drawing a freehand line around its
edges, as described in the Reducing the Bone Fragments section on
page 56.
Calibrate the image: Enables you to calibrate the selected images,
if required, as described in the Calibrating the Image section on page 36.
Getting Started with TraumaCad
TraumaCad User's Guide
Ruler tool: Enables you to measure a section of the image, as
described in the Ruler Tool section on page 70.
Angle tool: Enables you to measure an angle, as described in the
Angle Tool section on page 71.
Circle tool: Enables you to measure the diameter of any round
object, as described in the Circle Tool section on page 72 and in the
Calibrating the Image section on page 36.
Text Annotation tool: Opens a window in which you can type in a
textual annotation to be shown on the image. When text in added to the
image, a line shows the connection between the text and the part of the
image to which it applies. You can drag this text away if it is obstructing
the view. The line will lengthen and still point to the part of the image to
which the text applies.
LLD tool: This tool is used to measure leg length discrepancy,
as described on page 73.
Delete selected object: Enables you to delete a selected
measurement tool or implant that you have added onto the image using
TraumaCad. Click on the object that you wish to delete and then on this
tool.
Cut Fragment: Enables you to cut the fragment that you have
defined with the Define Fragment or Lasso tools.
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TraumaCad User's Guide
Duplicate Fragment: Once you have cut out a fragment you can
duplicate it onto the current image or onto another image. You may decide
to duplicate a fragment and then flip it in order to compare a fragment from
one limb to another limb. To navigate between images use the Page Up or
Page Down buttons
.
Copy to Clipboard: Enables you to copy the displayed image to the
clipboard, including the implants, textual annotations and measurement
tools that you added using TraumaCad. From there you can paste it to any
other application, such as a presentation.
New Case Study: When you launch TraumaCad, a new case study
is opened. Only one case can be open at a time. A case study may have
multiple images open, and each may have implants and measurements
drawn on it using TraumaCad. Opening a new case study removes all the
displayed images from view. Before opening a new case study make sure to
generate the required report and/or to commit the image back to the PACS
system.
Page Up or Page Down: A case study may have multiple
images open and each may have implants and measurements drawn on it
using TraumaCad. Use these tools to navigate between them.
Help: Displays information about TraumaCad.
Transpose: This tool is used during the Trauma procedure to
transpose the orientation of an implant between AP and lateral views.
Copy implant: Duplicates a selected implant.
Getting Started with TraumaCad
TraumaCad User's Guide
Flip Left-Right: Flips the selected implant or fragment left or right.
Fit to Screen: Click on this tool to go back to the original image
size after zooming in.
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Setting the PACS Configuration
(Optional)
This optional step only applies to standalone versions of TraumaCad. It
enables you to specify the connection properties between TraumaCad and
the PACS system. Typically, this only needs to be performed once by a
system administrator after the initial installation of TraumaCad. The system
administrator should make sure to enter the relevant connection properties
in the PACS system so that it recognizes TraumaCad.
NOTE:
Client/Server versions of TraumaCad can skip this step since it is performed on the
server, as described in the TraumaCad Adminstrator’s Guide.
To set up the PACS Configuration:
1
Click
. The DICOM Properties window is displayed:
Getting Started with TraumaCad
TraumaCad User's Guide
2
Enter the relevant PACS connection information into the appropriate
fields. This information should be available to your network
administrator.
3
Click OK to save and apply these settings.
Downloading Implant Templates
TraumaCad provides a large library of digital templates for a wide variety
of orthopedic surgical procedures.
For the server version of TraumaCad, these implant images are
automatically imported and updated on your computer from the TraumaCad
server.
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TraumaCad User's Guide
For the standalone version of TraumaCad, use the
button in the main window to download
templates of implants from Orthocrat’s global repository to your computer.
Each implant is provided in a variety of sizes and properties and each such
group is called an implant template. Several implanting scenarios can be
recorded and compared to find the optimal implant procedure. Once an
implant is chosen, it can easily be scaled and manipulated.
Before TraumaCad is used for the first time, the implant templates should
be imported. This procedure should also be performed from time to time to
update the template library.
Getting Started with TraumaCad
TraumaCad User's Guide
Templates Manager
After the Templates Downloader is launched, it assesses the locally stored
templates and the latest templates on the Orthocrat server.
The window lists the templates stored locally and those on Orthocrat's
server. The following describes the legend at the bottom of the Templates
Manager window:
Black Downloaded Templates: Templates which have been stored
locally.
Blue Not Downloaded Templates: Templates that are available for
downloading from Orthocrat's servers.
Red Expired Templates: Locally stored templates, for which a newer
version to be downloaded exists on Orthocrat's servers.
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To download templates to the local client:
1
Select the required templates by clicking the checkbox to the left of the
template name.
2
Click Download Selected Templates to start downloading the selected
templates.
3
(Optional) Search for specific templates (meaning, filter the list of
templates) by entering the template name or part of the name in the
Filter Templates field and clicking the
button to its left.
NOTE:
Rebuild Local index: It may take a long time to rebuild all local indexes. This option
should be used rarely and only by an administrator, unless templates were downloaded
not using TraumaCad or, for example, were copied to the computer from CD.
Preparing the Image
TraumaCad User's Guide
5Chapter 2
Preparing the
Image
TraumaCad supports DICOM and enables you to import (and export) any
PACS file (X-ray, CT or MR) from a central PACS system, a CD or from a
local workstation. JPG, scanner or digital camera images can also be
imported, and any image can be captured from the screen and used in
TraumaCad. TraumaCad then provides an automatic feature to ensure
accurate calibration to bone size.
After an image has been prepared in TraumaCad, you can start the required
surgical planning procedure, as described in Chapter 3, TraumaCad
Procedures, page 45.
Step 1: Displaying the Image
If TraumaCad is integrated into your PACS, then all you need to do to
access an image is to display it in the PACS, and then select the
TraumaCad option. The option to activate TraumaCad on an image may
differ from PACS to PACS. One PACS may activate TraumaCad by
pressing a button and another may be by right-clicking on the image and/or
selecting a menu option.
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The following options are provided for importing images:
Loading Images from a PACS, page 29.
Importing Images from a CD, page 32.
Capturing Images from the Screen, page 33.
Step 2: Specifying Anatomical Orientation
This step must be performed on all the images with which you want to
work in TraumaCad, as described on page 34.
Step 3: Calibrating the Image
This step may be performed on images with which you want to work in
TraumaCad, as described on page 4.
Preparing the Image
TraumaCad User's Guide
Loading Images from a PACS
Finding the Patient
TraumaCad is transparently integrated with the PACS system and enables
full access to its patient images and information. TraumaCad provides a
variety of options for finding a specific patient of interest. After you have
found the patient, you can select the images in which you are interested.
To find patient, perform any one of the following:
Click the Query
button to display a list of patients.
Typically, this list is sorted by Last Name, then First Name and then
Study Date, but this may differ between PACS systems.
1. Click the Query Button.
2. Sort the list by
clicking on the
required attribute.
3. Select the patient
of interest by clicking
on the desired row.
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You can scroll down in this list or sort the listed patients by clicking on
the name of a column at the top of the list. You can perform any of the
following options:
or
to display the patients whose
Click
images were scanned today or yesterday accordingly.
Select the From and or To check boxes and specify the range of
dates of interest. Click
this date range.
to see all the images within
Enter/select all or some of the patient’s information in the Patient
ID, Patient Name, Accession and Modality field and click
. You can also enter part of the Patient’s ID or
Patient’s name.
Click
to clear the patient search information that you
have entered and the list of patients that is displayed.
NOTE:
You may click the Purge Cache button to clear the cache of images on your
local computer.
Preparing the Image
TraumaCad User's Guide
Selecting the Patient’s Images
Once you have found the patient in which you are interested, you can select
the relevant images, an entire series or an entire study to be viewed. To
select any of these, double-click on the relevant row, or click the plus sign
to drill down and see the series in a study and then again to see the
images in a series. Double-click on an image to retrieve it from PACS and
display it in the TraumaCad window.
The following diagram shows how to drill down and select a specific image
in a series of a study.
1. Click on a study to
display the series
that it contains.
2. Click on a series to display the
images that it contains.
3. Double-click on an image to select it.
A thumbnail of this image is displayed.
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Importing Images from a CD
On the standalone version of TraumaCad, two options are provided for
importing images into your local cache on your local computer. You can
then commit these to the PACS system if you like. These are:
: Enables you to import a folder of
DICOM images to your local cache.
: Enables you to import a single image
file that is jpg, DICOM or another file format. A window is displayed
in which you can enter the information about this image that will be
stored with it.
WARNING!
When importing an image or using an image from the local cache, make sure that
you import data from the correct patient, and use the correct image from the
correct patient.
NOTE:
You may click the Purge Cache button to clear the cache of images on your local
computer.
Preparing the Image
TraumaCad User's Guide
Capturing Images from the Screen
Select the Screen Capture option in the File menu to capture any image
that is displayed on the screen into TraumaCad. The following window is
displayed:
Drag the Finder Tool
over the image to be captured. It is then added
to TraumaCad, and you can later commit it to PACS if you like.
WARNING!
When importing an image or using an image from the local cache, make sure that
you import data from the correct patient, and use the correct image from the
particular patient.
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Specifying Anatomical Orientation
After the images in which you are interested have been loaded from the
PACS or imported from a CD or your local computer, as described in the
previous sections, each of these images are displayed in the sidebar on the
left of the window. An example is shown below:
You can scroll up and down among the images that you have selected, if
you have selected more than two, and you can minimize the images of a
specific series, by clicking .
You can also scroll among the large images shown in the center right of the
window using the
bar.
Page Up or Page Down buttons in the tool
You should now indicate the anatomical orientation of each image, as
described below.
Preparing the Image
TraumaCad User's Guide
To indicate the anatomical orientation of each image:
1
Select whether the displayed image is AP or Lat by clicking on the
appropriate radio button. This step is mandatory.
2
Specify the side of the body shown in the image as Left or Right, by
clicking on the appropriate radio button. This option is not mandatory.
3
You can display the image in the main work area by double-clicking on
its thumbnail image or by clicking
, as shown below:
As shown above and as described in the section that follows, the
Calibration window is then automatically displayed.
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Calibrating the Image
To use an image for quantitative measurements, the image must be
calibrated to the actual bone size. The calibration status of the image
appears in the lower right corner of the image, as shown below.
Calibration
Status
Most images imported from PACS are already calibrated according to the
cassette. One of the most beneficial features of TraumaCad is its ability to
automatically calibrate an image to the actual bone size by calibrating the
image to a marker that is imaged with the patient.
Preparing the Image
TraumaCad User's Guide
For this purpose Orthocrat provides a spherical metal X-ray marker with a
diameter of 1 inch. The metal ball should be placed on the same plane
(meaning the same height or level) as the bone while performing the x-ray.
TraumaCad can then automatically detect this marker in an image and
calibrate the image to the actual bone size according to it.
X-ray Scaling
Direct linear measurements cannot be taken from plain x-rays because of
the unknown magnification factor inherent in the x-ray taking process.
X-rays are generated at a source point and radiate out from that point in a
divergent beam. The beam is directed through the person or object to be
imaged and then the shadow is recorded on the x-ray sensitive plate some
distance behind the object.
There are two ways of determining the magnification factor, as follows:
To know the distance from the source of the x-rays to the object and the
distance from the source to the x-ray plate.
To include an object of known size or a radio opaque ruler in the plane
of interest.
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Calibration Sphere
Orthocrat’s spherical metal X-ray marker scaling device is, of course, of the
second type mentioned above. This device is intended to be used to provide
a scale for plain x-rays, CR and DR (such as those commonly used in
orthopedics). The scaling sphere should be placed in the same plane as the
bone. The bone and sphere should therefore be the same distance from the
x-ray plate and the x-ray source.
When an x-ray image is scaled using a ruler or simple object, it is
impossible to verify whether the scale was placed in the correct plane at the
time of acquisition. The advantage of the sphere is that it is threedimensional and its diameter is constant from any angle that the x-ray is
taken.
NOTE:
Measurements performed on uncalibrated images are in pixel units, while in
calibrated images they are in millimeters.
Preparing the Image
TraumaCad User's Guide
Calibration Window
As shown previously, the selected image is displayed with a Calibration
window, which provides various options for calibrating the image. After
calibration is completed, as described in this section, click Accept
Skip Calibration
On page 45.
and proceed to Chapter 3, TraumaCad Procedures
The Calibration window appears as follows depending on whether
Orthocrat’s spherical metal x-ray marker is found or not.
Found
Not Found
If the marker is found, the message Metal Ball found where shown is
displayed in the window shown above. In this case you can click the
Accept
button.
or
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The selected image is then displayed in the work area, as shown below:
You can now click
Procedures on page 45.
and proceed to Chapter 3, TraumaCad
Even if the metal ball is found, you may decide to manually or semiautomatically calibrate the image, as described in the Calibrating the Image
section below.
If you decide not to calibrate the image, then click Skip Calibration
and proceed to Chapter 3, TraumaCad Procedures on page 45.
The following describes the various options for calibrating an image.
Preparing the Image
TraumaCad User's Guide
Calibrating an Image
If no marker is detected, you have three options, as follows:
to Skip Calibration by clicking
.
to manually indicate the position of the marker to which to calibrate, as
described below.
to manually resize the image by entering a percentage in the
Oversizing field (for example 15%) and clicking
.
Manually Indicating the Marker in the Image
To manually indicate the position of the marker you have three options:
To click on the spherical metal x-ray marker
This is a semi-automatic option which detects the entire spherical marker
once you click anywhere inside it in the image. To do so, click Select
another point
and then click inside the marker on the image.
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To use the Ruler tool
Use the Ruler tool to measure a section of the image whose size is known
to you. Click Use Ruler tool for calibration
window:
to display the following
Draw a line to indicate the size of the marker in the image the size of the
line is displayed on the image and changes as you draw and resize the line,
as shown below:
Preparing the Image
TraumaCad User's Guide
The size of the line is also shown in the Marking size field. If you know
that the marker’s actual size is one inch, then make sure that the Marking
size field shows that value. You can manually change it to adjust the size of
the line in the image.
When the line exactly covers the extent of the marker in the image, click
Accept
.
To use the Circle tool
Click Use Circle tool for calibration
window:
to display the following
Click on the marker in the image. A circle marker is automatically drawn,
as shown below:
Drag this anchor to the outer
rim of the Markers image here.
Drag this circle to exactly cover the marker.
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You can resize the circle, by manually changing the value in the Marking
size field. If you know that the marker’s actual size is one inch, then make
sure that the Marking size field shows that value.
You can also easily set the size of the circle to exactly cover the marker’s
image, by manually positioning (dragging) each of the three anchors (red
plus signs) of the circle onto the outer rim of the marker’s image.
The diameter of the circle is displayed on the image and changes as you
draw and resize the circle. When the circle exactly covers the extent of the
marker in the image, click Accept
.
TraumaCad Procedures
TraumaCad User's Guide
6Chapter 3
TraumaCad
Procedures
After you perform the three steps described on the first page of Chapter 2,
Preparing the Image on page 27, you have clicked Accept
the image’s calibration or Skip Calibration
to accept
to skip it and have then
. A list of procedures is then displayed for your
clicked
selection, as shown below:
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Select the surgical or analysis procedure to be performed on the patient. A
simple wizard will then lead you through the process of performing each
procedure, such as selecting and positioning an implant, if required.
The following describes each of these procedures and refers you to the
section of this chapter that contains detailed instructions.
Joint Replacement Procedures, page 46.
Trauma, page 53.
Pediatric Pelvis Tool, page 60.
Once you have completed each procedure you should generate a report
including textural information and transfer it to the OR, as described in the
Generate Reports section on page 65, and then commit the image back to
the PACS system, if required for future reference.
Joint Replacement Procedures
TraumaCad optimizes joint replacement procedures and is ideal for
complex reconstructions and osteotomies, as well as for standard primary
replacements. Surgeons can evaluate the post-operative anatomical
alignment of various surgical scenarios (cutting, displacing, implanting) to
create an optimal surgical plan. Incorporated into the patient file, this plan
helps ensure the success of the procedure, while reducing operating time.
TraumaCad offers a large and easily accessible template library for joint
replacement. This library is constantly updated automatically through the
server or manually in the standalone version.
Joint replacement procedures are similar for hip, knee, ankle, shoulder and
elbow. Refer to the following sections for a description of the main steps of
these procedures:
Selecting an Implant, page 47.
Specifying Implant Properties, page 50.
Positioning an Implant, page 52.
TraumaCad Procedures
TraumaCad User's Guide
Selecting an Implant
Read this section if you selected one of the replacement surgical procedures
or if you are placing an implant in one of the other procedures, such as
Trauma. The process of using TraumaCad for each of the replacement
procedures (hip, knee, ankle, shoulder and elbow) is similar.
Of course, the implant library differs for different anatomical regions, such
as a hip or a knee. The following window is shown when you select one of
the joint replacement procedures:
At this point you may want to use any of the variety of measurement tools
provided by TraumaCad to measure the anatomical region of the patient, as
described in Chapter 4, Measuring.
The process of identifying the required implant is also referred to as
Templating. During this process you will first select the appropriate implant
according to the available inventory, size and a variety of other properties.
You will then position it on the image on the appropriate anatomy.
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TraumaCad User's Guide
To select the appropriate implant(s):
1
Select the manufacturer of the implant from the Manufacturer field.
Selecting a manufacturer determines the types of implants that are
available for selection in the Types of Implant field.
2
Select the type of the implant from the Types of Implant field, such as
stems.
3
Select the implant product family from the Implants field. Many
implant products may be available for selection and you can scroll right
or left using the scroll bar under this list to see them all.
4
Click on the arrow
next to the implant product to see a preview
image of the implant, as shown below:
Click here to see preview.
TraumaCad Procedures
TraumaCad User's Guide
To save an implant in the Favorites tab:
1
Select the implant product family from the Implants field. Many
implant products may be available for selection and you can scroll right
or left using the scroll bar under this list to see them all.
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Specifying Implant Properties
Once you have selected the required implant you can position it on the
image and specify more properties of the implant to suit the surgical
procedure, such as its size, offset and number of attachments. You require
more than a single implant for a specific surgical procedure, such as a stem
and a cap.
To specify implant properties:
1
Double-click on the implants name in the implants list on the left. This
will place the implant in the center of the image.
or
Drag the implant from the list on the left onto the image.
Properties
A selection of properties appears on the left, as shown above.
TraumaCad Procedures
TraumaCad User's Guide
2
Specify the properties of the implant to suit the surgical procedure,
such as:
the size of the implant in the Size field.
the length of the implant in the Length field.
the angle between the pieces of the implant in the Offset field.
the color of the implant shown in the image in the Color field.
the neck length of the implant attachments in the Attachment field.
These properties differ according to the implant that is selected.
3
While selecting the appropriate implant for total hip replacement, take
note of the projected post-operative parameters: Offset and LLD
changes area on the bottom left of the window. These will indicate the
anatomical changes that will occur as a result of the procedure.
4
If at any point you want to place another implant on the image, simply
click the
button.
5
or the
If at any point you want to delete the selected implant from the image,
simply select it and press the Delete key or the Delete Selected Object
tool.
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Positioning an Implant
You should position the implant on the image according to surgical
considerations. A number of options are provided to enable you to position
an implant on the image.
To move an implant:
Make sure that the Move
drag it to the required position.
tool is selected, click on the implant and
To rotate an implant:
The selected implant is indicated by its light (highlighted color) and a
rotation handle, as shown below:
Rotation Handle
Hinge
Drag the rotation handle to the left, right, up or down to pivot the implant
around its hinge.
You can also flip an implant using the
Flip Left-Right tool, and
change it from AP to LAT and vice versa by using the
tool.
Transpose
TraumaCad Procedures
TraumaCad User's Guide
After selecting and positioning of the implant you can continue to the
second x-ray of the patient by clicking Next/Previous
. The
selected implant automatically appears in the new orientation. You should
position it on the image.
Trauma
TraumaCad is designed to meet the needs of the trauma environment.
TraumaCad enables you to define fracture fragments, move, rotate and
copy fragments on the image and between images to reconstruct on the
healthy side and accurately restore the anatomy on multiview images prior
to templating.
If you selected the Trauma surgical procedure, the steps for handling a
patient are identical to a replacement procedure except for the following
two steps:
Specifying the Anatomical Region, page 54.
Defining and Reducing the Bone Fragments, page 56. You may try
different options for reducing the fragments and then select the optimal
one.
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TraumaCad User's Guide
Specifying the Anatomical Region
After you select
, the following window is displayed:
To specifying an anatomical region of the body:
1
Move the mouse over each relevant area of the body on the skeletal
image on the left. As you do so, it is highlighted in red.
TraumaCad Procedures
TraumaCad User's Guide
2
Click on the relevant part of the body, to display the following:
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Reducing the Bone Fragments
to display the list of implants used in the image if there
Click
are any, as shown below:
Two tools are provided to define the bone fragments in the image:
Define Fragments
and Lasso
, as described below:
TraumaCad Procedures
TraumaCad User's Guide
Defining Fragments
To define fragments:
1
Select the Define Fragments
tool and make a series of clicks
along the outline of the fragment to be moved.
2
Close the outline drawing of the fragment by double-clicking. You now
have a closed shape that you can drag to a new position, as shown
below:
Pivot Point
Selection
Box
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TraumaCad User's Guide
You can now reposition or adjust the selection of the fragment as
required using any of the following options:
You can press the Esc key to delete the selected outline.
You can reshape the fragment outline by dragging any of the red
points on the outline.
The dot in the center of the fragment that you have traced is the
pivot point. If you drag the handle, the fragment will rotate around
it. You can also drag this pivot point to a new position and then
rotate the fragment by dragging its handle.
You can flip this fragment using the
Flip tool.
You can duplicate this fragment, copy it to another image and
delete it, using the
Duplicate Fragment,
Clipboard and the
Delete Selected Object tools.
Copy to
TraumaCad Procedures
TraumaCad User's Guide
Lasso Fragments
Lassoing fragments means to simply draw a line around the area of the
image that contains the fragments to be moved.
To lasso fragments:
1
Select the
2
Click and hold down the left mouse button and drag the mouse around
the area to be moved. A line will be drawn as you move the mouse, as
shown below:
Lasso tool.
3 After the fracture is reduced, you can add implants for fixation. For
details on how to perform this procedure, refer to the sections listed
below:
Selecting an Implant, page 47
Specifying Implant Properties, page 50
Positioning an Implant, page 52
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Pediatric Pelvis Tool
TraumaCad enables orthopedic surgeons to take anatomical measurements,
compare them to normative standards and to simulate corrective
procedures. Easy-to-use wizards help surgeons produce a wide range of
anatomical measurements. Each measurement is automatically compared to
the normal parameters published in the literature, providing instant
evaluations of patient anatomy. Measurements and evaluations integrate
into patient files for an easy transition to digital radiology.
The steps for using TraumaCad for pediatric analysis are as follows:
1
Select Pediatric Pelvis Tool.
2
Use the easy to follow wizard to mark anatomical points on the image
for pediatric analysis, as described in the Marking Anatomical Points
for the Pediatric Pelvis Tool section on page 61.
3
You have the option to use TraumaCad’s comprehensive growth
calculator tool, as described in the Growth Calculator section on
page 83.
4
Generate a report including textural information and transfer it to the
OR, as described in the Generate Reports section on page 65.
5
Commit the image back to the PACS system, if required for future
reference.
TraumaCad Procedures
TraumaCad User's Guide
Marking Anatomical Points for
the Pediatric Pelvis Tool
If you selected the Pediatric Pelvis Tool surgical procedure, the following
window is displayed:
Specify whether the Fermal head is fully, partially or non-ossified by
selecting the appropriate radio button on the left
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Then, click
to display the following:
TraumaCad Procedures
TraumaCad User's Guide
A wizard is displayed on the left which guides you through the process of
identifying anatomical markers by clicking on them in the image.
each time after
Following the displayed instructions and click
you perform them. The following shows an example of the image after the
fifth point has been marked:
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Once you mark the sixth point according to the instructions provided in the
sixth step of the wizard, the following is shown:
The Anatomical measurements are shown in the top left corner of the
window.
TraumaCad Procedures
TraumaCad User's Guide
Generating Reports
A report consists of textual information describing the patient, the
measurements, the surgical procedure to be performed and/or the implant to
be used and any text that the surgeon chooses to add.
The image appears with a textual overlay, measurement tools and the
implants, as shown below, and can be committed back to the PACS for
future reference.
WARNING!
The material generated by the program is two dimensional. Before performing a
procedure confirm that the actual bone matches the image produced by the
software.
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An example of an HTML textural report is shown below. It can be saved
locally or printed for future reference.
TraumaCad Procedures
TraumaCad User's Guide
To generate a report:
After you have specified an implant’s properties and positioned it as
, as described in the Specifying Implant
required, click
Properties section on page 50. The following is then displayed:
The following options are provided:
To select the image’s resolution and position of the text on the image.
To select the positioning of the text on the report.
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To click the
button in order to store this image in the
PACS system along with all the TraumaCad additions for future
reference.
: To copy the image to the clipboard from which you can
paste it into any application.
: To save the image locally as a JPEG file for any
purpose.
: To display an HTML textual report. Please save this
report or print it before opening anther case study.
: To preview the image to be stored.
: To export the measurements to an excel sheet. This
option is especially suited for research since each measurement is
added as a row in the excel sheet file that you specify. This enables you
to perform numerous measurements, even on different images, and to
store them in the same excel sheet, each measurement as a row.
Measuring the Anatomy
TraumaCad User's Guide
7Chapter 4
Measuring the
Anatomy
After you have calibrated the image you may want to measure the actual
anatomy in the image using a variety of tools provided by TraumaCad.
All of TraumaCad’s measurement tools can be accessed from the
Measurement Tools menu. The most frequently used tools can also be
accessed from the toolbar and by right-clicking on the image. These are
described below. The other tools can be used digitally in the same manner
that they are used for physical measurements.
NOTE:
To obtain quantitative measurements the image must first be calibrated, as
described in the Calibrating the Image section on page 36.
This chapter also describes the Growth Calculator on page 83 which
predicts the growth of a particular anatomy in pediatric orthopedics.
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Ruler Tool
The Ruler tool enables you to measure selected portions of an image either
in pixels (for uncalibrated images) or millimeters (for calibrated images).
To use the Ruler Tool:
1
After loading an image, either click the Ruler
tool or select the
Measurement Tools menu
Basic Measurements
and the Ruler
Tool or right-click on the image and select Rule Tool.
2
Left-click and hold the left mouse button on the image where you want
to start measuring.
3
Drag the mouse without releasing the left mouse button until the end of
the section to be measured.
4
Release the mouse. The measurement appears in pixels or millimeters
above the measurement bar as shown above.
Measuring the Anatomy
TraumaCad User's Guide
Angle Tool
The Angle tool enables you to measure the angle between two areas.
To use the Angle Tool:
1
Click
or select the Measurement Tools menu
Basic
Measurements
and the Angle Tool or right-click on the image and
select Angle Tool.
2
Left-click and hold the left mouse button on the image where you want
to start measuring.
3
Drag the mouse without releasing the left mouse button until you reach
the end of the section to be measured.
4
Release the mouse button. The measurement will appear in degrees
next to the angle as shown above.
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Circle Tool
Use the Circle tool to measure the diameter of round objects.
To use the Circle Tool:
1
Click
or select the Measurement Tools menu
Basic
Measurements
and the Circle Tool or right-click on the image and
select Circle Tool.
2
Left-click on the image in the work area. The Circle tool appears.
3
Left-click and hold the mouse button inside the circle and drag it to the
desired position, as shown below.
4
Click and drag on each of the three crosses in turn to adjust the size of
the circle.
5
The diameter measurement (in millimeters if calibrated) appears in the
upper half of the circle
Measuring the Anatomy
TraumaCad User's Guide
Leg Length Discrepancy Tool
The LLD tool enables you to measure leg length discrepancy.
To use the LLD Tool:
1
Click
or select the Measurement Tools menu
Basic
Measurements
and the LLD Tool or right-click on the image and
select Pelvic Tool.
2
Left-click on the image in the work area. The Pelvis Tool appears.
3
Using the red markers adjust the tool to reference points in order to
measure the leg length discrepancy, meaning the ischial tuberosity and
the center of the lesser trochanter, as shown in the image.
The number above the horizontal line indicates the discrepancy
between the right and left side in the distance between the two points. If
there is no discrepancy the number 0 will appear.
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Spine Tools
Sacral Obliquity
This tool measures the angular deviation of the sacrum from the line drawn
parallel to a line across the femoral heads on a supine AP view of the
sacrum, as shown below:
Measuring the Anatomy
TraumaCad User's Guide
Coronal Balance
This tool measures the difference in millimeters between two lines that are
drawn perpendicular to the film edge at an AP view: the first to the center
of S1 vertebra and the second to the center of C7 vertebra.
Sagittal Balance
This tool measures in a similar manner to the Coronal Balance, described
above, but for the LAT view.
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Cobb Angle
This tool measures the coronal and Sagittal spinal deformity as shown
below:
Measuring the Anatomy
TraumaCad User's Guide
Pediatric Tools
Reimer Index
The Reimer Index tool (the hip migration percentage) first measures, in the
horizontal plane, the part of the femoral head extending lateral to a vertical
line drawn from the lateral edge of the roof of the acetabulum (the Perkins
line). The migration percentage is then calculated by dividing this value by
the entire width of the visible part of the femoral head.
We recommend on using the Pediatric Pelvis Tool, as described on page
60, in which Reimer Index calculation is guided.
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Foot and Ankle Tools
Talar Tilt Tool
This tool measures the angle between a line drawn parallel to articular
surface of distal tibial to a line drawn parallel to talar surface.
Measuring the Anatomy
TraumaCad User's Guide
Geometrical Research Tools
These tools are made to evaluate the positioning of the hip implants
postoperatively, they are important for research and quality control.
Cup Inclination
The horizontal line should be adjusted to the ischial tuberosity.
The oblique line (and with it the outer circle) should be adjusted to
distalomedial and proximolateral ends of the implanted cup.
The inner circle should be adjusted to the opening of the implanted cup.
The cup abduction and ante-retroversion are displayed.
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AnteRetro version of the Femoral
Stem
The femoral stem angle should be determined for the specific stem that
was used.
The circle should be adjusted to the implanted head.
Next two points should be adjusted to the implanted femoral neck.
Next two sets of points should be adjusted to the implanted femoral
stem.
The calculated angle is the Ante/Retro version of the femoral stem
(only when the thigh is at neutral rotation).
Measuring the Anatomy
TraumaCad User's Guide
Pelvic Tools
Pelvic Radius Angle
This tool measures the angle substanded by a line from the center of the
femoral head to the posterior superior corner of S1 and a line drawn along
the sacral end plate.
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VCA Angle of Luquesne
This tool defines a vertical line passing through the center of the femoral
head and a line joining the center of the femoral head and the anterior point
of the Acetabular roof at the false profile view.
Measuring the Anatomy
TraumaCad User's Guide
Growth Calculator
You can select the Launch Growth Calculator option from the
Measurements Tools menu, to display the following window.
Each tab of this window provides different options for predicting the
growth of a particular anatomy in pediatric orthopedics, as follows:
Height Prediction Page
Purpose: Predicts the height of this patient at maturity.
Formula: Predicted Height = Current Height x Height Multiplier (specific
for age and sex, using a normal chart)
Leg Length Prediction Page
Purpose: Predicts leg length at maturity.
Formula: Predicted length at maturity = Current Length x Multiplier
(specific for age and sex, using a lower limb chart)
Growth remaining = Current length - predicted length
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Arm Length Prediction Page
Purpose: Predicts the length of an arm at maturity.
Formula: Predicted length at maturity = Current Length x Multiplier
(specific for age and sex)
Growth remaining = Current length - predicted length
Leg Length Discrepancy Prediction - Congenital
Page
Purpose: Predicts the leg length discrepancy at maturity for this patient
with congenital LLD. (Congenital = Congenital femoral deficiency, fibular
hemimelia, tibial hemimelia, hemihypertrophy, hemiatrophy, posteromedial
bow of tibia)
Formula: Predicted length discrepancy at maturity = Current Length
Discrepancy x Multiplier (specific for age and sex, using a lower limb
chart)
Leg Length Discrepancy Prediction Developmental Page
Purpose: Predicts the leg length discrepancy at maturity for this patient
with developmental LLD. (Developmental = Ollier’s, polio, growth arrest,
also works for congenital discrepancies after lengthening)
Formulas:
Predicted length discrepancy at maturity = current difference + [1- (short
leg current – short leg previous)/(long leg current – long leg previous)] x
Long leg current (Multiplier (specific for age and sex using a lower limb
chart)-1)
Inhibition = 1- (short leg current – short leg previous)/(long leg current –
long leg previous)
Measuring the Anatomy
TraumaCad User's Guide
Arm Length Discrepancy Prediction - Congenital
Page
Purpose: Predicts arm length discrepancy at maturity for this patient with
congenital LLD. (Congenital = hemihypertrophy, hemiatrophy)
Formula: Predicted length discrepancy at maturity = Current Length
Discrepancy x Multiplier (specific for age and sex, using an upper limb
chart)
Arm Length Discrepancy Prediction Developmental Page
Purpose: Predicts arm length discrepancy at maturity for this patient with
developmental LLD? [Developmental = Ollier’s, polio, growth arrest, also
works for congenital discrepancies after lengthening]
Formulas:
Predicted length discrepancy at maturity = current difference + [1- (short
arm current – short arm previous)/(long arm current – long arm previous)] x
Long arm current (Multiplier (specific for age and sex using upper limb
chart)-1)
Inhibition = 1- (short arm current – short arm previous)/(long arm current –
long arm previous)
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Timing of Epiphyseodesis at the Knee Page
Purpose: Suggests the timing for epiphyseodesis around the knee of a long
limb to equalize the limb length discrepancy at maturity.
Formulas:
Multiplier at correct age for epiphyseodesis = [current long leg length x
current multiplier specific for age and sex using lower limb chart] / (current
long leg length x current multiplier specific for age and sex using lower
limb chart) - desired correction / kappa
Kappa should be calculated for 3 scenarios: distal femur = 0.71,
Proximal tibia = 0.57, Both distal femur and prox. tibia = 0.67
The resultant Multiplier at age correct for epiphyseodesis must be
“translated” back to a chronologic age using the lower extremity Multiplier
chart specific for age and sex
Timing of Stapling for Hemi-epiphyseodesis Page
Purpose: Suggests the timing for hemi-epiphyseodesis around the knee to
correct angular deformities, if the staple will not be removed.
Formulas:
Multiplier at correct age for hemi-epiphyseodesis = [current bone length x
current multiplier specific for age and sex using lower limb chart] /
([current bone length x current multiplier specific for age and sex using
lower limb chart] – [(width of the growth plate x desired correction/57)/
kappa]
Kappa should be calculated for one of two scenarios: distal femur = 0.71,
proximal tibia = 0.57
The resultant Multiplier at age correct for hemi-epiphyseodesis must be
“translated” back to a chronologic age using the lower extremity Multiplier
chart specific for age and sex.
Measuring the Anatomy
TraumaCad User's Guide
Timing of Staple Removal for Hemiepiphyseodesis Page
Purpose: Suggests the timing for removing a staple inserted for hemiepiphyseodesis around the knee to correct angular deformities, assuming
that the stapling was done well prior to skeletal maturity.
Formulas:
Multiplier at correct age for removal of hemi-epiphyseodesis staple =
[current bone length x current multiplier specific for age and sex using
lower limb chart] / ([current bone leg length + [(width of the growth plate x
desired correction/57)/ kappa]
Kappa should be calculated for one of two scenarios: distal femur = 0.71,
Proximal tibia = 0.57
The resultant Multiplier at age for removal of hemi-epiphyseodesis staple
must be “translated” back to a chronologic age using the lower extremity
Multiplier chart specific for age and sex
CDC Growth Charts
The growth charts consist of a series of percentile curves that illustrate the
distribution of selected body measurements in children in the United States.
The 1977 growth charts were developed by the National Center for Health
Statistics (NCHS) as a clinical tool for health professionals to determine if
the growth of a child is adequate. The 1977 charts were also adopted by the
World Health Organization for international use.
When the 1977 NCHS growth charts were first developed, NCHS
recommended that they be revised periodically as necessary. With more
recent and comprehensive national data now available, along with
improved statistical procedures, the 1977 growth charts have been revised
and updated to make them a more valuable clinical tool for health
professionals.
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The 2000 CDC growth charts represent the revised version of the 1977
NCHS growth charts. Most of the data used to construct these charts come
from the National Health and Nutrition Examination Survey (NHANES),
which has periodically collected height, weight and other health
information about the American population since the early 1960's.
Limb Alignment Analysis
TraumaCad User's Guide
8Chapter 5
Limb Alignment
Analysis
TraumaCad enables orthopedic surgeons to take anatomical measurements,
compare them to normative standards and simulate corrective procedures.
Easy-to-use wizards help surgeons produce a wide range of anatomical
measurements. Each measurement is automatically compared to the normal
parameters published in the literature and to the contralateral limb,
providing instant evaluations of patient anatomy. Measurements and
evaluations integrate into patient files for an easy transition to digital
radiology.
To perform limb alignment analysis are as follows:
1
Select Limb Alignment Analysis.
3
Use the wizard to mark anatomical points on the image for limb
alignment analysis, as described in page 2.
4
You can simulate osteotomies and implant fixation, as described in
page 3.
3
You have the option to use TraumaCad’s comprehensive growth
calculator tool, as described in the Growth Calculator section on
page 83 of the user manual.
4
Generate a report including textural information and transfer it to the
OR, as described in the Generate Reports section on page 65 of the
user manual.
5
Commit the image back to the PACS system, if required for future
reference.
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Marking Anatomical Points
Select the Limb Alignment Analysis surgical procedure in the following
window:
For an AP image, specify whether you want to measure unilaterally or
bilaterally by selecting the appropriate radio button.
Limb Alignment Analysis
TraumaCad User's Guide
Bilateral
Click
to display the following for the bilateral measurements:
mLDFA – mechanical Lateral Distal Femoral Angle.
mMPTA – mechanical Medial Proximal Tibial Angle.
mLDTA – mechanical Lateral Distal Tibial Angle.
A wizard is displayed on the left of the image which guides you through the
process of identifying anatomical markers by clicking on them in the
image.
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The following shows an example of the image after the thirteenth point has
been marked:
Once you mark the fourteenth point according to the instructions you will
be asked to adjust the marked points.
Limb Alignment Analysis
TraumaCad User's Guide
The next image will be displayed:
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The Anatomical measurements are shown in the top left corner of the
window, right, left, and normal for angles, or discrepancy for bone and limb
length.
Limb Alignment Analysis
TraumaCad User's Guide
Unilateral
Click
to display the following measurements:
mLDFA – mechanical Lateral Distal Femoral Angle.
mMPTA – mechanical Medial Proximal Tibial Angle.
mLDTA- mechanical Lateral Distal Tibial Angle.
A wizard is displayed on the left which guides you through the process of
identifying anatomical markers by clicking on them in the image.
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The following shows an example of the image after the sixth point has been
marked:
Once you mark the seventh point according to the instructions you will be
asked to adjust the marked points.
Limb Alignment Analysis
TraumaCad User's Guide
The next image will be displayed:
The Anatomical measurements are shown in the top left corner of the
window.
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Lateral
For a Lateral image, there are only unilateral measurements:
Click
to display the following lateral measurements:
aPDFA – anatomical Posterior Distal Femoral Angle.
aPPTA – anatomical Posterior Proximal Tibial Angle.
aADTA- anatomical Anterior Distal Tibial Angle.
A wizard is displayed on the left which guides you through the process of
identifying anatomical markers by clicking on them in the image.
Limb Alignment Analysis
TraumaCad User's Guide
Once you mark the tenth point according to the instructions you will be
asked to adjust the marked points.
The next image will be displayed:
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The Anatomical measurements are shown in the top left corner of the
window.
Limb Alignment Analysis
TraumaCad User's Guide
Osteotomies Simulation
After completing the limb alignment measurements, a simulation of
osteotomies and implant selection can be done.
Define the distal fragment using the “Define Fragments"
Fragments"
or "Lasso
tools.
Cut the distal fragment using the "Cut Fragments"
tool.
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Drag the red circle to the desired CORA (Center Of Rotation of the
Angulation). The CORA can be measured by using the knee tools of the
measurements tools on the toolbar, or manually for simple deformities.
Simulation of the osteotomies can be done now by moving the green dot or
by clicking on the Ctrl button while moving the distal fragment with the
mouse.
Limb Alignment Analysis
TraumaCad User's Guide
The projected post operative measurements are displayed in the table.
Now you can zoom in and measure the osteotomy's parameters.
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You have the option to choose implants as shown in the Selecting an
Implant section.
You have the option to use TraumaCad’s comprehensive growth calculator
tool, as described in the Growth Calculator section on page 83 of the
user manual.
Generate a report including textural information and transfer it to the OR,
as described in the Generate Reports section on page 65 of the user
manual.
Commit the image back to the PACS system, if required for future
reference.